Can infected composite mesh be salvaged?

Abstract

Background

Composite mesh, once infected, creates a difficult dilemma. Many times, the mesh is deemed unsalvageable and leads to removal and potentially more morbidity. This article describes successful salvage of infected composite mesh.

Methods

Retrospective chart review of composite mesh placed at a single community hospital from January 2002 to November 2007.

Results

A total of 356 composite mesh implants were placed: 218 Ventralex and 138 Composix Kugel. All had open repairs; 153 were men and 203 were women with a mean age of 45.3 years (range 21–90), and a mean body mass index of 33.3 (range 20–60). Eleven patients developed mesh-related infections, presenting an average of 42 days postoperatively (range 10 days to greater than 4 years post repair). All were treated initially with conservative measures. Four patients ultimately required mesh removal (all had Composix Kugel repairs). Seven patients, however, (one Ventralex and six Composix Kugel) were successfully salvaged with conservative office-based methods, including dressing changes, local wound debridement, partial mesh excision, wound vacuum, and antibiotics. None of the salvaged infected composite mesh patients developed hernia recurrences after at least 3 years.

Conclusions

As long as there is no evidence of extensive mesh infection or overt sepsis, infected composite mesh can be salvaged. Treatment of these often complex patients must be individualized.